CPT 29425: Lower Leg Cast Application with Walking Accommodation
Medicare pays $84 and commercial payers pay $273 on average nationally for this procedure.
CPT code 29425 describes application of a lower leg cast for fractures of the tibia and/or fibula or severe ankle sprain, where the clinician forms the cast bottom to accept a cast shoe or applies a footplate with a rubber heel to permit ambulation when weight bearing is allowed; service type: cast application/immobilization, typical site of service: emergency department, orthopaedic clinic, or ambulatory surgery/urgent care setting.
For related coverage guidance, see recent payer policy updates: Medical Necessity Guidelines Non-Emergency Transportation, Non-Emergent Transportation Medical Policy, Non-Emergency Facility to Facility Transfers.
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National Reimbursement Benchmarks
Medicare’s mean rate of $83.5 sits well below BUCA’s average commercial mean of $273.5, indicating a sizable gap between public fee schedules and this commercial benchmark. That divergence highlights how reimbursement levels for CPT 29425 differ by payer type: Medicare aligns near the lower end of the national spectrum while BUCA represents a substantially higher commercial average.
Looking at dispersion using the interquartile range (P75–P25), Blue Cross Blue Shield shows the widest spread with a range of $142.0 ($486.3–$332.3), suggesting greater variability in contracted rates. Aetna and UnitedHealth Group are relatively tighter, with ranges of $52.9 ($81.6–$33.0) and $71.8 ($151.8–$79.4) respectively. Cigna’s IQR of $92.1 ($171.0–$78.6) sits between these extremes.